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California’s Climate Change: Single-Payer

By Stuart A. Bussey, MD, JD, UAPD President

Two seemingly unconnected events last Thursday remind us that we live in a progressive, independent-minded state. First, the California Senate passed SB 562 (Lara/D), the Healthy California single-payer bill. This bill purports to solve our state’s health care access problem, which has been partially relieved by the ACA and is now threatened by the new AHCA bill. The California Assembly is preparing for the weighty debate on how exactly to pay for SB 562’s universal coverage. Cost estimates range from $330 billion/year (UMass study) to $400 billion/year (legislative analysis). These figures are comparable to the 2016 estimate of California’s health care cost of $370 billion. Much of this money would be available as repurposed Medicare and Medi-Cal money — and the Feds would have to agree. The State, under Healthy California, would take on the role of single insurer. The plan would be governed by a nine member board of experts who would authorize payments to hospitals, doctors, ancillaries and pharmaceutical firms in a hybridized and collectively bargained fee-for-service paradigm. The collective bargaining part of the bill could elevate UAPD as a preeminent representative of many of California’s providers. Physicians probably would be working at discounted rates of reimbursements, but they would at least be paid promptly and by one entity (the State). They would not have to play tiresome reimbursement and authorization games with dozens of profit-motivated insurance companies. Doctors should spend less time billing and more time with their patients.

Make no mistake — single-payer will require more taxes to support it. Under one scenario a 15% payroll tax on California employers would raise $200 billion. Under another plan, a 2.3% business tax and a 2.3% sales tax could raise over $100 billion. However, there are other less ambitious, more modular ways to improve health care access to the uninsured in our state. UAPD has been taking part in a diverse health care coalition of unions, county government, and businesses. The goal is to explore and develop proposals, consensus, and legislation to maintain and expand the gains of the ACA. Besides the aforementioned single-payer bill, there are discussions of county-based initiatives, a public health option, and extending Medi-Cal to millions of undocumented workers. All of these require fresh revenue. But because single-payer is so ambitious, these more modest alternatives may be more feasible in the short term.

Also last Thursday, President Trump pulled the US out of the multinational Paris Climate Accord, which was largely brokered by the world’s top two polluters, the US and China. Immediately, California Governor Jerry Brown, longtime champion of alternative energy, called Trump’s decision “insane.” He vowed to seek a broader role in shaping the world’s climate change policies. In fact, Brown was in China this week to promote clean energy and co-host a forum of the Under2 Coalition to plan carbon-cutting efforts. Following California’s lead, other states (Washington, New York) hundreds of cities (Los Angeles, Atlanta, Pittsburgh) and many giant corporations (Apple, Google, Chevron) have vowed to follow and meet the goals of Paris—to reduce the world’s carbon footprint and make it a healthier place to live.

Climate change across the world is accepted by most as a fact. In California our change of climate is manifested not only by more CO2, heat, smog and drought — but by changing political winds, and a change in the will of our leaders in the administration and legislature. They seek a climate of forward thinking and innovation. If our federal government won’t encourage a healthy environment or inclusive health care policy, California should take the lead. And our union of health care providers stands ready to participate in this evolution. Please feel free to give me your feedback on these issues.